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Christoffersen NB, Nilou FE, Thilsing T, Larsen LB, Østergaard JN, Broholm-Jørgensen M. Exploring targeted preventive health check interventions - a realist synthesis. BMC Public Health 2023; 23:1928. [PMID: 37798691 PMCID: PMC10557298 DOI: 10.1186/s12889-023-16861-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 09/29/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Preventive health checks are assumed to reduce the risk of the development of cardio-metabolic disease in the long term. Although no solid evidence of effect is shown on health checks targeting the general population, studies suggest positive effects if health checks target people or groups identified at risk of disease. The aim of this study is to explore why and how targeted preventive health checks work, for whom they work, and under which circumstances they can be expected to work. METHODS The study is designed as a realist synthesis that consists of four phases, each including collection and analysis of empirical data: 1) Literature search of systematic reviews and meta-analysis, 2) Interviews with key-stakeholders, 3) Literature search of qualitative studies and grey literature, and 4) Workshops with key stakeholders and end-users. Through the iterative analysis we identified the interrelationship between contexts, mechanisms, and outcomes to develop a program theory encompassing hypotheses about targeted preventive health checks. RESULTS Based on an iterative analysis of the data material, we developed a final program theory consisting of seven themes; Target group; Recruitment and participation; The encounter between professional and participants; Follow-up activities; Implementation and operation; Shared understanding of the intervention; and Unintended side effects. Overall, the data material showed that targeted preventive health checks need to be accessible, recognizable, and relevant for the participants' everyday lives as well as meaningful to the professionals involved. The results showed that identifying a target group, that both benefit from attending and have the resources to participate pose a challenge for targeted preventive health check interventions. This challenge illustrates the importance of designing the recruitment and intervention activities according to the target groups particular life situation. CONCLUSION The results indicate that a one-size-fits-all model of targeted preventive health checks should be abandoned, and that intervention activities and implementation depend on for whom and under which circumstances the intervention is initiated. Based on the results we suggest that future initiatives conduct thorough needs assessment as the basis for decisions about where and how the preventive health checks are implemented.
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Affiliation(s)
- Nanna Bjørnbak Christoffersen
- Research Program On Health and Social Conditions, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Freja Ekstrøm Nilou
- Research Program On Health and Social Conditions, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Trine Thilsing
- Research Unit of General Practice, University of Southern, Odense, Denmark
| | - Lars Bruun Larsen
- Research Unit of General Practice, University of Southern, Odense, Denmark
- Steno Diabetes Center Zealand, Holbæk, Denmark
| | | | - Marie Broholm-Jørgensen
- Research Program On Health and Social Conditions, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
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Morris M, Halcomb E, Mansourian Y, Bernoth M. Understanding how general practice nurses support adult lifestyle risk reduction: An integrative review. J Adv Nurs 2022; 78:3517-3530. [PMID: 35775138 PMCID: PMC9796034 DOI: 10.1111/jan.15344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 05/18/2022] [Accepted: 06/16/2022] [Indexed: 12/30/2022]
Abstract
AIM To review the literature exploring how general practice nurses support lifestyle risk reduction. DESIGN Integrative literature review. SOURCES CINAHL, Emcare, MEDLINE, Proquest and Scopus were searched for peer-reviewed primary research published in English from 2010 to 2022. METHODS Sixteen papers met the inclusion criteria and were assessed for methodological quality using the Mixed Methods Appraisal Tool. Findings were extracted and thematically analysed. RESULTS Four themes described general practice nurses: (1) Establishing relational connections; (2) Empowering active participation; (3) Engaging mutual motivation and (4) Enabling confident action. General practice nurses used complex interpersonal, risk communication and health coaching skills to build collaborative partnerships that supported patients' self-determination and self-efficacy. While mutual motivation and confidence were reciprocally enabling, gaps in skills, experience and knowledge plus time, resource and role constraints limited general practice nurses' ability to support lifestyle risk reduction. CONCLUSION General practice nurses play a key role in lifestyle risk reduction. Ongoing education, funding, organizational and professional support are needed to enhance their commitment, confidence and capacity. IMPACT What problem did the study address? While general practice nurses play a key role in health promotion and risk reduction, their potential is yet to be fully realized. Research examining methods by which nurses working in general practice support lifestyle risk reduction is limited. What were the main findings? Successful interactions depended on personal, professional, organisational and systemic factors which either enhanced or inhibited relational quality, shared decision-making, mutual commitment, and nurses' confidence and capacity to address lifestyle risks. Targeted professional development and peer mentoring are needed to build proficient practice. Where and on whom will the research have impact? Understanding how general practice nurses support risk reduction can inform policy and identify training and support needs to advance their skills and role. Research exploring synergies between themes may illuminate this process.
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Affiliation(s)
- Maksi Morris
- School of Nursing, Paramedicine and Healthcare Sciences, Faculty of ScienceCharles Sturt UniversityWagga WaggaNSWAustralia
| | - Elizabeth Halcomb
- School of Nursing, Faculty of Science, Medicine & HealthUniversity of Wollongong, Illawarra Health & Medical Research InstituteWollongongNSWAustralia
| | - Yazdan Mansourian
- School of Information and Communication Studies, Faculty of Arts and EducationCharles Sturt UniversityWagga WaggaNSWAustralia
| | - Maree Bernoth
- School of Nursing, Paramedicine and Healthcare Sciences, Faculty of ScienceCharles Sturt UniversityWagga WaggaNSWAustralia
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Agrawal S, Makuch S, Lachowicz G, Dróżdż M, Dudek K, Mazur G. How Sociodemographic Factors Impact the Utilization of Recommended Clinical Preventive Screening Services in Poland: A Nationwide Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413225. [PMID: 34948831 PMCID: PMC8701877 DOI: 10.3390/ijerph182413225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/30/2021] [Accepted: 12/13/2021] [Indexed: 12/03/2022]
Abstract
Cardiovascular disease (CVD) and cancer are the most frequent causes of mortality in Poland. To date, no study in Poland has attempted to analyze the impact of sociodemographic factors on the utilization of all recommended preventive services for these diseases. To address this challenge, a nationwide cross-sectional study was conducted. One thousand adults aged 18 years or older were interviewed using computer-assisted telephone surveys conducted via random selection. A representative population was obtained in accordance with existing demographics per voivodeship in Poland. We assessed whether factors such as age, gender, body mass index (BMI), net income, household size, place of residence, and education impacted the odds ratio of utilizing recommended preventive services for CVD and cancer. We determined that elderly patients receive influenza vaccination, measure blood pressure, PSA concentration, glucose and lipid profiles, and undergo colonoscopy and mammography more often than younger counterparts. Men were more often influenza vaccinated (OR = 1.56, 95% CI: 1.07–2.27) than women, while women measured blood glucose more often than men (OR = 0.62, 95% CI: 0.42–0.93). Furthermore, net income < 2000 PLN, BMI < 24 kg/m2 and at least secondary education level were found to be crucial predictors of undergoing mammography (OR = 2.16; 95% CI: 1.26–3.72), cervical smear tests (OR = 1.99, 95% CI: 1.24–3.17), and lipid measurements (OR = 1.76, 95% CI: 1.07–2.91), respectively. Educating people and financial support seem to play a crucial role in implementing novel campaigns and preventive programs in Poland. Addressing each significant factor may be of paramount importance in improving the receipt of preventive services and warranting greater preventive care coverage in the Polish population.
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Affiliation(s)
- Siddarth Agrawal
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska St. 213, 50-556 Wrocław, Poland; (G.L.); (G.M.)
- Correspondence: ; Tel.: +48-71-736-40-00; Fax: +48-71-736-40-09
| | - Sebastian Makuch
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, St. K. Marcinkowskiego 1, 50-368 Wrocław, Poland;
| | - Gabriella Lachowicz
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska St. 213, 50-556 Wrocław, Poland; (G.L.); (G.M.)
| | - Mateusz Dróżdż
- Faculty of Medicine, Wroclaw Medical University, J. Mikulicza-Radeckiego 5, 50-345 Wrocław, Poland;
| | - Krzysztof Dudek
- Faculty of Mechanical Engineering, Wroclaw University of Science and Technology, St. I. Łukasiewicza 5, 50-371 Wrocław, Poland;
| | - Grzegorz Mazur
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska St. 213, 50-556 Wrocław, Poland; (G.L.); (G.M.)
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Leeman J, Boisson A, Go V. Scaling Up Public Health Interventions: Engaging Partners Across Multiple Levels. Annu Rev Public Health 2021; 43:155-171. [PMID: 34724390 DOI: 10.1146/annurev-publhealth-052020-113438] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Advancing the science of intervention scale-up is essential to increasing the impact of effective interventions at the regional and national levels. In contrast with work in high-income countries (HICs), where scale-up research has been limited, researchers in low- and middle-income countries (LMICs) have conducted numerous studies on the regional and national scale-up of interventions. In this article, we review the state of the science on intervention scale-up in both HICs and LMICs. We provide an introduction to the elements of scale-up followed by a description of the scale-up process, with an illustrative case study from our own research. We then present findings from a scoping review comparing scale-up studies in LMIC and HIC settings. We conclude with lessons learned and recommendations for improving scale-up research. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Jennifer Leeman
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA;
| | - Alix Boisson
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA;
| | - Vivian Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA;
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Promoting physical activity in primary care: a systematic review and meta-analysis. Br J Gen Pract 2021; 71:e399-e405. [PMID: 33824160 PMCID: PMC8049206 DOI: 10.3399/bjgp.2020.0817] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/23/2020] [Indexed: 01/17/2023] Open
Abstract
Background Promoting physical activity is an important part of patient care in primary care and has been investigated in many studies with a wide range of intervention characteristics, often including external support. It is unclear, however, if promoting physical activity is effective. Aim To investigate the effectiveness of behaviour change interventions to promote physical activity in primary care. Design and setting This is a systematic review and meta-analysis to evaluate physical activity promotion in a primary care setting. Method EMBASE, MEDLINE, PsycInfo, and the Joanna Briggs Institute Database were searched for ‘physical activity’, ‘interview’, ‘motivation’, ‘primary care’, and equivalent words to identify randomised controlled trials with physical activity as the outcome at patient level. Results The review identified 25 eligible studies. The quality appraisal showed that most studies reported insufficient details regarding randomisation, group allocation, blinding, and fidelity of intervention delivery. The included studies reported a wide range of interventions with varying numbers of follow-up visits or phone calls. The overall effect size for interventions with a 6-month follow-up interval was 0.04 (95% confidence interval [CI] = −0.06 to 0.14), and for interventions with a 12-month follow-up interval it was 0.19 (95% CI = 0.03 to 0.36). Only one intervention based on three motivational interviewing sessions achieved a moderate effect. Conclusion Counselling to promote physical activity in primary care has a limited effect on patients’ behaviour and it might not, on its own, be enough to change physical activity behaviour.
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Berry CA, Nguyen AM, Cuthel AM, Cleland CM, Siman N, Pham-Singer H, Shelley DR. Measuring Implementation Strategy Fidelity in HealthyHearts NYC: A Complex Intervention Using Practice Facilitation in Primary Care. Am J Med Qual 2020; 36:270-276. [PMID: 32964719 DOI: 10.1177/1062860620959450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Few studies have assessed the fidelity of practice facilitation (PF) as an implementation strategy, and none have used an a priori definition or conceptual framework of fidelity to guide fidelity assessment. The authors adapted the Conceptual Framework for Implementation Fidelity to guide fidelity assessment in HealthyHearts NYC, an intervention that used PF to improve adoption of cardiovascular disease evidence-based guidelines in primary care practices. Data from a web-based tracking system of 257 practices measured fidelity using 4 categories: frequency, duration, content, and coverage. Almost all (94.2%) practices received at least the required 13 PF visits. Facilitators spent on average 26.3 hours at each site. Most practices (95.7%) completed all Task List items, and 71.2% were educated on all Chronic Care Model strategies. The majority (65.8%) received full coverage. This study provides a model that practice managers and implementers can use to evaluate fidelity of PF, and potentially other implementation strategies.
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Affiliation(s)
- Carolyn A Berry
- NYU Langone Health, New York, NY New York City Department of Health and Mental Hygiene, New York, NY New York University, New York, NY
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Ten-Year Follow-Up of Clinical Governance Implementation in Primary Care: Improving Screening, Diagnosis and Control of Cardiovascular Risk Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214299. [PMID: 31694294 PMCID: PMC6862228 DOI: 10.3390/ijerph16214299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/02/2019] [Accepted: 11/04/2019] [Indexed: 02/03/2023]
Abstract
Current improvement strategies for the control of cardiovascular risk factors (CRFs) in Europe are based on quality management policies. With the aim of understanding the effect of interventions delivered by primary healthcare systems, we evaluated the impact of clinical governance on cardiovascular health after ten years of implementation in Catalonia. A cohort study that included 1878 patients was conducted in 19 primary care centres (PCCs). Audits that comprised 13 cardiovascular health indicators were performed and general practitioners received periodic (annual, biannual or monthly) feedback about their clinical practice. We evaluated improvement in screening, diagnosis and control of the main CRFs and the effects of the feedback on cardiovascular risk (CR), incidence of cardiovascular disease (CVD) and mortality, comparing baseline data with data at the end of the study (after a 10-year follow-up). The impact of the intervention was assessed globally and with respect to feedback frequency. General improvement was observed in screening, percentage of diagnoses and control of CRFs. At the end of the study, few clinically significant differences in CRFs were observed between groups. However, the reduction in CR was greater in the group receiving high frequency feedback, specifically in relation to smoking and control of diabetes and cholesterol (Low Density Lipoprotein (LDL) and High Density Lipoprotein (HDL)). A protective effect of having a cardiovascular event (hazard ratio (HR) = 0.64, 95% confidence interval (CI) = 0.44-0.94) or death (HR = 0.55, 95% CI = 0.35-0.88) was observed in patients from centres where general practitioners received high frequency feedback. Additionally, these PCCs presented improved cardiovascular health indicators and lower incidence and mortality by CVD, illustrating the impact of this intervention.
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Mäntyselkä P, Kautiainen H, Miettola J. Beliefs and attitudes towards lifestyle change and risks in primary care - a community-based study. BMC Public Health 2019; 19:1049. [PMID: 31382938 PMCID: PMC6683394 DOI: 10.1186/s12889-019-7377-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/26/2019] [Indexed: 11/29/2022] Open
Abstract
Background Promoting a positive lifestyle change is a challenge for primary health care. The aim of this study was to analyze health and risk-related beliefs and attitudes in relation to lifestyle and lifestyle change in a rural community. Methods The study was based on a five-year follow-up data of the Lapinlahti study (N = 361). The same structured questionnaire was used at baseline and follow-up with lifestyle items. These were ranked as unhealthy (− 1), neutral (0) or healthy (+ 1). At baseline, participants took a stand on 29 statements related to beliefs and attitudes towards health and health promotion on a 5-point Likert scale. A factor analysis yielded two attitude factors (Factor 1 = underrating risks/resistant to change); (Factor 2 = helplessness/pessimism). The factors were divided into tertiles. Results There was a linear positive trend (P < 0.001) in baseline lifestyle scores between the tertiles of Factor 1. A positive follow-up change of lifestyle score was found in all tertiles of Factor 1. For Factor 2, the difference between tertiles at baseline was non-significant. There was a significant positive change in all tertiles of Factor 2. Those who were underrating/ resistant but not helpless/pessimistic had the most significant positive lifestyle change. Those who were underrating/resistant and helpless/pessimistic did not improve their lifestyles. Conclusions Beliefs and attitudes are related to lifestyle. Subjects with underrating and resistant attitudes with pessimism/helplessness seem to have a low potential for lifestyle change while those with resistant attitudes without pessimism and helplessness may have the most significant potential for lifestyle change. These findings suggest that it is possible to identify different groups of people with different needs and readiness and ability for health behavior change.
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Affiliation(s)
- Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition (General Practice), School of Medicine, University of Eastern Finland, 70211-FIN, P.O.Box 1627, Kuopio, Finland. .,Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Juhani Miettola
- Institute of Public Health and Clinical Nutrition (General Practice), School of Medicine, University of Eastern Finland, 70211-FIN, P.O.Box 1627, Kuopio, Finland
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Krogsbøll LT, Jørgensen KJ, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database Syst Rev 2019; 1:CD009009. [PMID: 30699470 PMCID: PMC6353639 DOI: 10.1002/14651858.cd009009.pub3] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND General health checks are common elements of health care in some countries. They aim to detect disease and risk factors for disease with the purpose of reducing morbidity and mortality. Most of the commonly used individual screening tests offered in general health checks have been incompletely studied. Also, screening leads to increased use of diagnostic and therapeutic interventions, which can be harmful as well as beneficial. It is therefore important to assess whether general health checks do more good than harm. This is the first update of the review published in 2012. OBJECTIVES To quantify the benefits and harms of general health checks. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, two other databases and two trials registers on 31 January 2018. Two review authors independently screened titles and abstracts, assessed papers for eligibility and read reference lists. One review author used citation tracking (Web of Knowledge) and asked trial authors about additional studies. SELECTION CRITERIA We included randomised trials comparing health checks with no health checks in adults unselected for disease or risk factors. We did not include geriatric trials. We defined health checks as screening for more than one disease or risk factor in more than one organ system. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias in the trials. We contacted trial authors for additional outcomes or trial details when necessary. When possible, we analysed the results with a random-effects model meta-analysis; otherwise, we did a narrative synthesis. MAIN RESULTS We included 17 trials, 15 of which reported outcome data (251,891 participants). Risk of bias was generally low for our primary outcomes. Health checks have little or no effect on total mortality (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.97 to 1.03; 11 trials; 233,298 participants and 21,535 deaths; high-certainty evidence, I2 = 0%), or cancer mortality (RR 1.01, 95% CI 0.92 to 1.12; 8 trials; 139,290 participants and 3663 deaths; high-certainty evidence, I2 = 33%), and probably have little or no effect on cardiovascular mortality (RR 1.05, 95% CI 0.94 to 1.16; 9 trials; 170,227 participants and 6237 deaths; moderate-certainty evidence; I2 = 65%). Health checks have little or no effect on fatal and non-fatal ischaemic heart disease (RR 0.98, 95% CI 0.94 to 1.03; 4 trials; 164,881 persons, 10,325 events; high-certainty evidence; I2 = 11%), and probably have little or no effect on fatal and non-fatal stroke (RR 1.05 95% CI 0.95 to 1.17; 3 trials; 107,421 persons, 4543 events; moderate-certainty evidence, I2 = 53%). AUTHORS' CONCLUSIONS General health checks are unlikely to be beneficial.
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Affiliation(s)
- Lasse T Krogsbøll
- RigshospitaletNordic Cochrane CentreBlegdamsvej 9, 7811CopenhagenDenmark2100
| | | | - Peter C Gøtzsche
- RigshospitaletNordic Cochrane CentreBlegdamsvej 9, 7811CopenhagenDenmark2100
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Parker SM, Stocks N, Nutbeam D, Thomas L, Denney-Wilson E, Zwar N, Karnon J, Lloyd J, Noakes M, Liaw ST, Lau A, Osborne R, Harris MF. Preventing chronic disease in patients with low health literacy using eHealth and teamwork in primary healthcare: protocol for a cluster randomised controlled trial. BMJ Open 2018; 8:e023239. [PMID: 29866737 PMCID: PMC5988137 DOI: 10.1136/bmjopen-2018-023239] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/20/2018] [Accepted: 05/11/2018] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Adults with lower levels of health literacy are less likely to engage in health-promoting behaviours. Our trial evaluates the impacts and outcomes of a mobile health-enhanced preventive intervention in primary care for people who are overweight or obese. METHODS AND ANALYSIS A two-arm pragmatic practice-level cluster randomised trial will be conducted in 40 practices in low socioeconomic areas in Sydney and Adelaide, Australia. Forty patients aged 40-70 years with a body mass index ≥28 kg/m2 will be enrolled per practice. The HeLP-general practitioner (GP) intervention includes a practice-level quality improvement intervention (medical record audit and feedback, staff training and practice facilitation visits) to support practices to implement the clinical intervention for patients. The clinical intervention involves a health check visit with a practice nurse based on the 5As framework (assess, advise, agree, assist and arrange), the use of a purpose-built patient-facing app, my snapp, and referral for telephone coaching. The primary outcomes are change in health literacy, lifestyle behaviours, weight, waist circumference and blood pressure. The study will also evaluate changes in quality of life and health service use to determine the cost-effectiveness of the intervention and examine the experiences of practices in implementing the programme. ETHICS AND DISSEMINATION The study has been approved by the University of New South Wales (UNSW) Human Research Ethics Committee (HC17474) and ratified by the University of Adelaide Human Research Ethics committee. There are no restrictions on publication, and findings of the study will be made available to the public via the Centre for Primary Health Care and Equity website and through conference presentations and research publications. Deidentified data and meta-data will be stored in a repository at UNSW and made available subject to ethics committee approval. TRIAL REGISTRATIONREGISTRATION NUMBER ACTRN12617001508369; Pre-results.
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Affiliation(s)
- Sharon M Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Nigel Stocks
- Discipline of General Practice, University of Adelaide, Adelaide, South Australia, Australia
| | - Don Nutbeam
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Louise Thomas
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Nicholas Zwar
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Jon Karnon
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Jane Lloyd
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Manny Noakes
- Nutrition and Health Program, CSIRO Health and Biosecurity, Adelaide, South Australia, Australia
| | - Siaw-Teng Liaw
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Annie Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Richard Osborne
- School of Health and Social Development, Centre for Population Health Research, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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